Liver transplantation for primary sclerosing cholangitis: screening for biliary malignancy and the role of preemptive transplantation

Patt, Cary H.; Thuluvath, Paul J.

doi:10.1097/00075200-200206000-00004

Cited by 8 publications

(6 citation statements)

References 38 publications

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“…This method has been applied for several years, but has been hampered by insufficient sensitivity, whereas specificity has been fair. 24,25 In a recent study from our hospital, 121 cytology specimens from 61 patients were collected prospectively. Eight patients proved to have CCA; in another seven patients, high grade dysplasia/CCA in situ was diagnosed.…”

Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Liver Transplantation in Primary Sclerosing Cholangitis

et al. 2006

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Primary sclerosing cholangitis (PSC) represents an important indication for liver transplantation. Selection for and timing of liver transplantation is difficult due to the disease course and the frequent occurrence of hepatobiliary malignancies. Pretransplantation screening of malignancies is difficult, but brush cytology of the biliary ducts seems to represent a possibility for early detection of some cholangiocarcinomas. Patient and graft survivals following liver transplantation are good, with 1 year patient survival exceeding 90%. Survival is also satisfactory in patients with early detected or highly limited cholangiocarcinomas. Recurrent PSC represents a particular problem, and affects as many as 20 to 40% in a long-term perspective. Few predictors of recurrent disease have been identified; severe rejections and their treatment may be of importance.

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Section: Inflammatory Bowel Diseasementioning

confidence: 99%

Liver Transplantation in Primary Sclerosing Cholangitis

et al. 2006

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“…(3–15) Thus some have speculated that “preemptive” transplantation may reduce the risks of developing cholangiocarcinoma. (16)…”

Section: Introductionmentioning

confidence: 99%

Current Trends in Living Donor Liver Transplantation for Primary Sclerosing Cholangitis

Goldberg¹,

French²,

Thomasson³

et al. 2011

Transplantation

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Background Use of the Model for End-Stage Liver Disease (MELD) score has improved the efficiency of allocating deceased donor organs for liver transplant. However, its use may reduce access to deceased donor livers for patients with primary sclerosing cholangitis (PSC) due to the weighting of the MELD score variables. To overcome such barriers in the post-MELD era, clinicians might refer patients with PSC, relative to patients without PSC, for living donor transplants more frequently. Methods To test this hypothesis, we examined patients in the UNOS database from December 1st, 1994-May 31st, 2009. Results In multivariable models conditioned on transplant center, patients with PSC were significantly more likely to receive a living donor transplant in both the pre-MELD (OR=2.75; 95% CI 2.20–3.44) and post-MELD eras (OR=4.08; 95% CI 3.45–4.82). There was a significant interaction between PSC and post-MELD era of transplantation (OR=1.48; 95% CI 1.11–1.97), indicating that patients with PSC were more likely to receive living donor transplants at baseline relative to patients without PSC, and that this effect was magnified following the introduction of the MELD score. Conclusions These findings raise the possibility that allocating livers on the basis of MELD score may have yielded the unintended consequence of increasing rates for living donor transplants for patients with PSC relative to patients with other forms of end-stage liver disease. Future research is needed to determine whether the practice of selectively transplanting patients with PSC with living donor transplants is associated with differences in clinical outcomes.

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“…A strategy involving early, preemptive liver transplantation to avoid CCA development has been discussed, but since only a proportion of the patients develops CCA or end-stage liver disease, this strategy does not seem to be justified [15]. We should rather aim to diagnose early CCA (i.e.…”

Section: Discussionmentioning

confidence: 99%